Policy. Practice. Research.

09/14/2012

Can We Find Political Common Ground to Improve Population Health?

By David A. Kindig, MD, PhD

The next two
months will be filled with harsh and divisive campaigning, deepening the
ideological divide that characterizes our politics these days. Both conventions
seemed primarily designed to energize their bases, by emphasizing the sharpest
differences between the political “tribes.” Perhaps this is necessary in today’s
politics, but it doesn’t bode well for population health policy over the coming
decade. Improving population health will require cutting health care costs
while preserving access and quality, enabling better health behaviors,
improving education, economic growth, and the physical environment while also
increasing social support and social capital. These are decisions that will
require careful, nuanced decisions that go far beyond simplified political
exchanges.

Last Labor
Day I blogged on my summer read of Friedman and Mandelbaum’s book That
Used To Be Us: How America Fell Behind in the World It Invented and How We Can
Come Back,
and their call for third party movement or even a new party which seeks to find
common ground on such major challenges facing the country. This summer, I
continued in this genre with Jonathan Haidt’s The Righteous Mind: Why Good
People are Divided by Politics and Religion. Haidt is a
social/moral psychologist, now at the NYU Stern School of Business. The book is
a breathtaking synthesis of psychology, philosophy, evolutionary theory, anthropology,
genetics, and political science. The book jacket poses these two questions:
“Why can’t our political leaders work together as threats loom and problems
mount? Why do people so readily assume the worst about the motives of their
fellow citizens?”

Haidt sets
out to answer these questions by dissecting what he calls our “moral intuition”
(essentially our instantaneous perceptions of the world around us), arguing that
our moral intuition operates much more quickly and strongly than rational
thought processes. Through exhaustive psychological research, he identifies six
moral foundations that he suggests characterize, in different proportions,
global cultural and political “moral maps.” These include Care/Harm, Liberty/Oppression,
Fairness/Cheating, Loyalty/Betrayal, Authority/Subversion, and Sanctity/Degradation.
(NOTE: for those interested in his ideas, these terms require a fuller
elaboration than I have space for here because they are more nuanced than they appear
at first glance).

He argues
that these different foundations have a partial genetic basis, which can be
modified by early development and later life experience. In addition, he
asserts they have evolved in different societies and cultures to define a dominant
moral intuition that he believes plays a powerful role in explaining our
beliefs and ideologies. One prominent strand of argument is that while we are
basically selfish, evolution does promote group interests to some extent.

With respect
to American political culture, Haidt cites evidence, mostly from studying
twins, that 30-50% of political attitudes have a genetic basis, with most
differences between liberal and conservatives relating to sensitivity to
threats and openness to new experience. His most relevant finding is that liberals
bind together and primarily operate from the first three foundations above,
while conservatives have a more balanced moral map or intuition across all six
foundations. He argues that this produces a conservative advantage and explains
why rural and working class voters often vote Republican: they are voting their
moral interests which do not only focus on “the care of victims and the pursuit
of social justice” as Democrats tend to but also include attention to Authority
and Sanctity as well.

So what does this have to do with improving our
health? If Haidt is fundamentally correct in his assertion that our political
and ideological affiliations have a substantial genetic and evolutionary basis,
and that liberals and conservatives differ in some of the dominant moral
foundations from which they inherently operate, we had better understand those
differences more fully if we are going to find ways to work together to address
our nation’s challenges, including the many policies relevant to population
health improvement. Does the goal of better health only address liberal moral
foundations like Care and Fairness, or are there elements of conservative moral
intuition that can help in finding common ground? I don’t yet have answers to these important
questions, but look forward to others joining me in pondering this provocative area.

David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.